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https://nyti.ms/2udduvG

POLITICS

Vote
Delayed
as
Republicans
Struggle
to
Marshal
Support
for
Health
Care
Bill
By JENNIFER STEINHAUER and THOMAS KAPLAN JUNE 27, 2017

WASHINGTON Facing intransigent Republican opposition, Senator Mitch

McConnell of Kentucky, the Republican leader, announced on Tuesday that he will
delay a vote on his legislation to repeal the Affordable Care Act, dealing President
Trump an embarrassing setback on a key part of his agenda.

Republican leaders had hoped to take a page from the playbook used to get a
bill over the line in the House, appeasing the most conservative members of their
conference while pressuring moderates to fall in line with fewer concessions.

But as opposition mounted in both camps, even against a vote just to take up
the bill, Mr. McConnell decided he would delay consideration until after the
Senates weeklong July 4 recess.

We will not be on the bill this week, but we will still be working to get at least
50 people in a comfortable place, Mr. McConnell said.

That delay does not guarantee the senators will come together. Opposition
groups will mount pressure campaigns on lawmakers in their home states, and
policy divisions are deep.

Its hard to see how tinkering is going to satisfy my personal concerns, Senator
Susan Collins, Republican of Maine, told reporters.

Negotiations on Tuesday that leaders hoped would move senators toward yes
only exposed the fissures in the Republican Party. Conservatives were demanding
that states be allowed to waive the Affordable Care Acts prohibition on insurance
companies charging sick people more for coverage and are asking for a more
expansive waiver system for state regulators. They also wanted more money for
tax-free health savings accounts to help people pay for private insurance.

Senators from states that expanded the Medicaid program and Senator
Susan Collins would not brook many of those changes, especially the measure to
severely undermine protections for people with pre-existing medical conditions.
They wanted more money for mental health benefits for people addicted to opioids
and money for states to cover people left behind by the rollback of the Medicaid
program in both the House and Senate versions.

Three Republican senators Ms. Collins, Rand Paul of Kentucky and Ron
Johnson of Wisconsin had announced they would vote against the motion to
begin debate that had been scheduled to hit the Senate floor on Wednesday,
joining Senator Dean Heller of Nevada, who made the same pledge on Friday.

A bevy of other senators from both flanks of the party seemed headed in the
same direction if they did not see changes made to the Senate health care bill,
leaving the measure in deep peril, since Republicans can only lose two votes from
their own party.

The release of a Congressional Budget Office evaluation on Monday did little

to help leaders roll up votes from either side of the fence. The budget office said the
Senate bill would leave 22 million more uninsured after 10 years, while sending
out-of-pocket medical expenses skyrocketing for the working poor and those
nearing retirement.

The budget office did not provide conservatives with support for their
demands either. The state waivers already in the Senate bill would probably cause
market instability in some areas and would have little effect on the number of
people insured by 2026, the analysis concluded. Adding still more waivers,
including one that could allow insurers to price the sick out of the health care
market, could deprive even more people of health care.

Even before Mr. McConnells decision, White House officials had braced for
the likelihood that the procedural vote would fail and that they would have to
revisit the measure after the Fourth of July recess when they hoped to be able to
woo Mr. Johnson, who has been a surprisingly fierce critic of the bill from the
right. The senator has repeatedly warned that this week is too soon to vote on the
health care measure, as Republican senate leaders have insisted they need to do.

Vice President Mike Pence, attended the Senate Republican lunch on Tuesday
and then broke off for private meetings with Mr. Heller, a seemingly firm no and
the first moderate Republican to break with Mr. McConnell over the bill, and Rob
Portman of Ohio, who is feeling pressure from his states governor, John R. Kasich,
to oppose the bill and defend Ohios Medicaid expansion.

Mr. Portman was the subject of a spirited evaluation of his open criticism of
the bill by Mr. McConnell, who was frustrated with the expansion-state senators
who showed their hand early to other wavering colleagues, dooming the bill for
now. Mr. McConnell was unhappy that Mr. Portman seemed to be abandoning his
previous stance on fiscal rectitude by opposing Medicaid cuts in the bill.

But the Ohio senator was getting it from both sides. Mr. Kasich appeared in
Washington on Tuesday to sharply criticize the Senate bill. The governor said he
was deeply concerned about millions of people losing coverage under the bill.

Who would lose this coverage? Mr. Kasich said. The mentally ill, the drug
addicted, the chronically ill. I believe these are people that need to have coverage.

At the same news conference, Colorados Democratic governor, John W.

Hickenlooper, said his states Republican senator, Cory Gardner, understands the
hardships and the difficulties in rural life.

This bill would punish people in rural Colorado, Mr. Hickenlooper said,
raising the pressure.

Doctors, hospitals and other health care provider groups came out strongly
against the Senate bill, as did patient advocacy groups like the American Heart
Association. But business groups were ramping up their support. In a letter on
Tuesday, the U.S. Chamber of Commerce endorsed the Senate bill and urged
senators to vote for it.

The Senate bill will repeal the most egregious taxes and mandates of the
Affordable Care Act, allowing employers to create more jobs, said Jack Howard, a
senior vice president of the group. The bill, he noted, would repeal a tax on medical
devices and eliminate penalties on large employers that do not offer coverage to
employees.

A separate letter expressing general support for the Senates efforts was sent
by a coalition of 28 business and employer groups including the National
Association of Home Builders, the National Restaurant Association and the
National Retail Federation.

But Senate conservatives found themselves squeezed between business

sentiment and their conservative base. Club for Growth, an ardently conservative
political action committee, came out strongly against the Senate measure on
Tuesday.

The Club for Growth and the American people took Republicans in Congress
at their word when they promised to repeal every word root and branch of
Obamacare and replace it with a patient-centered approach to health care, the
groups president, David McIntosh, said in a statement. Only in Washington does
repeal translate to restore. Because thats exactly what the Senate GOP healthcare
bill does: it restores Obamacare.

Even the Trump administration is divided over what comes next, especially on
the payment of subsidies to health insurance companies to compensate for
reducing out-of-pocket costs for low-income people.

Mr. Trump has threatened to withhold the monthly payments as a way to

induce Democrats to bargain with him over the future of the Affordable Care Act.
Administration officials said Mr. Trump did not want to make the payments if the
Senate did not pass a health care bill this week. But they said Tom Price, the
secretary of health and human services, had urged the White House not to cut off
the payments abruptly.

A federal judge has ruled that the payments are illegal because Congress never
appropriated money for them, but that ruling is being appealed. Any interruption
of the payments could have a dire destabilizing effect on markets, insurers say.
Blue Cross Blue Shield of North Carolina recently blamed the Trump
administrations mixed signals on the subsidy for most of its proposed 23 percent
spike in premiums next year.

Sean Spicer, the White House press secretary, defended the administrations
position at his briefing on Friday.

If the president were to hypothetically say that hes going to make the
payments in perpetuity or for a year, I think that continues to prop up a failed
system, Mr. Spicer said. It continues to do wrong by the American taxpayer. And
it also doesnt lend itself to the expediency that I think we want to help get a new
health care system in place.
 Robert Pear and Emmarie Huetteman contributed to this report.

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